Provider First Line Business Practice Location Address:
7608 W HIGHWAY 146
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
PEWEE VALLEY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40056-8100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-241-5055
Provider Business Practice Location Address Fax Number:
502-241-5799
Provider Enumeration Date:
12/01/2008